HCPs Desire More Education in Opioid, Chronic Pain Management

Surveys revealed that although the vast majority recognize opioid abuse as a priority, only 36% screen for past or current abuse

The following article features coverage from PAINWeek 2017 in Las Vegas, Nevada. Click here to read more of MPR‘s conference coverage.

Results of a study presented at Pain Week 2017 found that, although healthcare providers (HCPs) feel “generally comfortable” treating patients with opioids, they desire more education and training in various aspects of opioid and chronic pain management.

Twenty-five paper assessment surveys from HCPs from various practice settings in New Jersey and Tennessee were analyzed. The providers were asked anonymously about their demographics, training, awareness, and practices on managing chronic opioid therapy. All parameters were reported using descriptive statistics.

Analysis of the HCPs’ demographics found that 44% of survey respondents were nurse practitioners, 36% were physicians, and 28% were from family or internal medicine practices. 64% of survey respondents reported having ³11 years of experience.

“While 7 of 25 respondents (28%) said their patients are receiving opioid therapy for an extended period (>3 months), 9 of 25 respondents (36%) said this represented less than 10% of their population,” the study authors reported. Analysis of the data also found that, although 68% of providers reported being comfortable with treating patients with opioids for >3 months (mean score: 5.8; 1-10 scale), 44% of respondents stated they avoided prescribing opioids.

Data from the study revealed that only 36% of respondents reported screening for past or current substance abuse. Survey analysis also found that 64% of respondents utilize their state’s prescription drug monitoring program (PDMP) while 88% reported receiving training on it within the last 2 years.

“Providers were most interested in receiving training on universal precautions (64%) and use of opioids to manage chronic pain (56%),” stated the authors. Additionally, survey analysis found that respondents preferred live educational programs to other educational activities.

The study found that, although most providers feel comfortable with prescribing opioids for chronic pain management, they desire additional education on this topic, particularly concerning universal precautions.

Read more of MPR‘s coverage of PAINWeek 2017 by visiting the conference page.

Virtual Reality: A Viable Resource in Combating the Opioid Epidemic?

LAS VEGAS — Virtual reality (VR) is on the verge of revolutionizing pain management, including on the chronic pain front, and may offer a new way to combat the opioid crisis, according to a presentation by Ted Jones, PhD, a pain psychologist at the Behavioral Medicine Institute in Knoxville, Tennessee, at PAINWeek 2017, held September 5-9 in Las Vegas, Nevada.1

According to the Centers for Disease Control and Prevention (CDC), 91 Americans die every day from an opioid overdose, and prescription opioids are a known driving factor in these deaths.2 In 2012, 259 million prescriptions were written for opioids, enough for every adult in the United States to have their own bottle of pills.3 While opioids remain the standard of care for treating acute severe pain and chronic pain from an advanced illness, abuse and addiction pose major challenges.

“We need alternatives for opioid pain treatment. Psychological therapies like cognitive behavioral therapy and mindfulness are effective, but most of our patients won’t practice these like they need to, so they are of limited utility for us. VR is easy to do. Put a visor on and you’re there,” Dr Jones told MPR. “Past studies have shown that VR is very good at pain relief, so we need to adapt what has been done to date and develop new ways of treating pain in our opioid[-taking] pain population. We could be on the verge of a new era of pain treatment in which medications are rarely used, and VR is a primary treatment modality.”

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VR has been leveraged for pain management since 1996, when it was first used to alleviate severe acute burn pain in patients treated at the Harborview Burn Center in Seattle, Washington.4 Since then, VR has been shown to provide significant analgesia in many other acute pain settings, including during wound debridement and dental procedures and following surgery.1 More recently, studies have indicated VR to be efficacious for the treatment of chronic pain, including 2 studies led by Dr Jones.5,6

The first study included 30 patients with chronic pain treated with a 5-minute Cool! VR session. During these sessions, patients wore the Oculus Rift headset and virtually travelled a preset route in a computer-generated fantasy world, where they encountered small otters, which they could cast fish or fire-orbs at.5 Assessments showed a 66% reduction in pain during the session and a 33% reduction in pain at the end of the session.

The second study, which included 10 patients with neuropathic pain, showed similar results.6 Participants received three 20-minute VR sessions 1 week apart. Assessments revealed a 69% reduction in pain during each session and a 53% pain reduction immediately after each session. “As a comparison, morphine is generally thought to reduce pain 25% to 30%,” said Dr Jones.

Cool! and other distraction-related VR therapies are based on the gate control theory of pain, which postulates that pain perception can be reduced by refocusing the brain’s attention away from the pain. While distraction-based approaches have shown good efficacy, companies on the forefront of VR pain treatment development are working to push this technology toward even more immersive and personalized experiences. One such company, CogniSense, a Silicon Valley-based startup, is working on a modulated VR distraction therapy that uses data analytics to optimize analgesic effects, as well as a completely new type of VR therapy, which they have dubbed “VR Neuro-Therapy.”

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VR Neuro-Therapy is a patent-pending technology that combines the immersive power of VR with implicit learning and other techniques to change how the brain perceives pain,” CogniSense co-founder and CEO Tassilo Baeuerle told Clinical Pain Advisor. Because the goal of this therapy is to address the underlying neuropsychological issues that contribute to pain perception, such as catastrophization, it might be a particularly powerful tool for combatting chronic pain. Current VR distraction techniques have not been shown to change such psychological variables.1

Mr Baeuerle envisions that VR Neuro-Therapy may eventually become a powerful alternative or adjunct to pain drugs, thereby reducing or potentially eliminating opioid prescribing in many patient populations. “We hope one day it can be used to avoid prescribing opioids, particularly strong opioids, to patients at high risk of addiction. It could then also be used to help wean addicted patients off opioids or enable a chronic pain patient already on opioids to avoid taking a higher opioid dose,” he explained.

While VR Neuro-Therapy is still a few years away from being commercially available, it and other VR technologies are providing a ray of hope in the ongoing battle against the opioid epidemic.

Read more of MPR‘s coverage of PAINWeek 2017 by visiting the conference page.

One Comment

In respect to these and all articles we either write ourselves or re-post on our website for example the Picture talking about Chiropractic Care when it comes to Chronic Pain I truly believe it can work for some of us. But both Patient and Chiropractor must recognize when efforts in treatment have failed. At this time a referral should be made for a Board Certified Pain Management Specialist without delay. I applaud these Chiropractic Specialist for their approach with chronic pain and would see one in 2 seconds flat if my disease process was something they could treat. I will be personally making myself a appointment for other Pain Related problems that Opioids would numb but I would rather keep my opioid use for the more serious pain involved with CIPD.